Form UB-106-A-FF "Weekly Claim for Unemployment Insurance (Ui) Benefits" - Arizona

Form UB-106-A-FF, Weekly Claim for Unemployment Insurance (UI) Benefits, is a legal document you need to complete to verify that you were unemployed during the report week and are eligible to receive benefit payments - Arizona Unemployment Insurance, or AZUI, payments. Fill out this form if you have applied for AZUI benefits or have an existing AZUI claim with a monetary balance.

Alternate Name:

  • Arizona Unemployment Insurance Claim.

An AZUI Weekly Claim filing is mandatory each week for as long as you do not have a job, meet all the eligibility requirements, and want to claim the benefits. A determination will not be made unless you filed a claim regardless of your AZUI Weekly Claim status. All weeks must be filed in order, without breaks. Failing to do so may result in a delay in having your benefits approved.

This form was released by the Arizona Department of Economic Security (ADES). The latest version of the form was issued on April 1, 2020, with all previous editions obsolete. A UB-106-A-FF fillable form can be downloaded through the link below.

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UB-106-A-FF Instructions

To complete the AZUI Weekly Claim, you need to answer the following questions:

  1. Were you able to work and available for work each workday?
  2. Did you look for work? You must show an active effort to seek employment that you are suited for by education, training, and experience. Name the employer and person contacted, the method of contact, record the type of work you sought and the action you took subsequently.
  3. Did you refuse any job offers or referrals to work?
  4. Did you earn any money for your work? Enter the amount of gross earnings, name the company you separated from, indicate the reason for separation from the employer, and your last day of work.
  5. Have you returned to full-time work?
  6. Do you choose to skip filing for the week because you did not comply with the work search requirements?

When you complete the form, indicate your name, social security number, and record the ending date of the report week. Sign the document and write down the actual date. There are two ways to send Form UB-106-A-FF to the ADES:

  • Fax the form to 602-364-1210 or 602-364-1211 (for Phoenix) and 520-770-3357 or 520-770-3358 (Tucson);
  • Mail the form to the Arizona Department of Economic Security, PO Box 29225, Phoenix AZ 85038-922.
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ARIZONA DEPARTMENT OF ECONOMIC SECURITY
UB-106-A -FF (4-20)
Page 1 of 2
Unemployment Insurance Program
Weekly Claim for Unemployment Insurance (UI) Benefits
Name
Social Security Number
Week Ending Date
You may file your weekly claim for UI Benefits on the Internet at AZUI.COM. You can also return this form by fax or mail
with the information provided below. Filing on the Internet may result in faster payment of benefits because the mail
delivery and processing time would be eliminated
Guidance for answering the following questions is located on page 2 of this form.
Is your unemployment due to coronavirus 2019 (COVID-19)?
Yes
No
Answer these questions for the week that ended on the date above.
1. Were you able to work and available for work each regular workday?
Yes
No
2. Did you look for work?
(DES temporarily suspended the “actively seeking work” requirement due to COVID-19. Your answer to question 2 will
not be used to determine your eligibility at this time.)
3. Did you refuse any job offer or referral to work?
Yes
No
4. Did you work or earn any money, including part-time work?
Yes
No
The department regularly matches hiring information with employer records. Failure to report
earnings may result in prosecution and payment of restitution. (If YES, you must answer 4a. and 4b.)
4a. What were your gross earnings before deductions?
$
4b. Are you still working? (If NO, check reason for separation, and answer 4b1 and 4b2 below.)
Yes
No
Lack of work
Quit
Fired or Discharged
Labor Dispute
4b1. Name of company you separated from:
4b2. What was your last day of work?
5. Have you returned to full-time work which will not require you to file any further weekly claims at this time?
Yes
No
Failure to disclose that you have returned to work may result in prosecution and payment of restitution.
6. Do you choose to skip filing for the week because you did not meet the work search requirements in #2 above?
(DES temporarily suspended the “actively seeking work” requirement due to COVID-19. Your answer to question 6 will
not be used to determine your eligibility at this time.)
I am claiming benefits for the calendar week that ended on Saturday midnight, as shown above. I certify to the following:
I was registered for work and unemployed. The above statements are true and correct to the best of my knowledge.
I have reported all changes in writing. I understand that the law provides penalties for false statements made in
connection with this claim and if any issues arise from my answers above, the department will contact me.
Claimant’s Signature
Date
When completed, fax to:
You may also mail to: Arizona Department of Economic Security
602-364-1210 or 602-364-1211 (Phoenix)
Unemployment Insurance Benefits
520-770-3357 or 520-770-3358 (Tucson)
MD 5895
P.O. Box 29225
Phoenix AZ 85038-955
See page 2 (Instructions) for EOE/ADA disclosures.
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
UB-106-A -FF (4-20)
Page 1 of 2
Unemployment Insurance Program
Weekly Claim for Unemployment Insurance (UI) Benefits
Name
Social Security Number
Week Ending Date
You may file your weekly claim for UI Benefits on the Internet at AZUI.COM. You can also return this form by fax or mail
with the information provided below. Filing on the Internet may result in faster payment of benefits because the mail
delivery and processing time would be eliminated
Guidance for answering the following questions is located on page 2 of this form.
Is your unemployment due to coronavirus 2019 (COVID-19)?
Yes
No
Answer these questions for the week that ended on the date above.
1. Were you able to work and available for work each regular workday?
Yes
No
2. Did you look for work?
(DES temporarily suspended the “actively seeking work” requirement due to COVID-19. Your answer to question 2 will
not be used to determine your eligibility at this time.)
3. Did you refuse any job offer or referral to work?
Yes
No
4. Did you work or earn any money, including part-time work?
Yes
No
The department regularly matches hiring information with employer records. Failure to report
earnings may result in prosecution and payment of restitution. (If YES, you must answer 4a. and 4b.)
4a. What were your gross earnings before deductions?
$
4b. Are you still working? (If NO, check reason for separation, and answer 4b1 and 4b2 below.)
Yes
No
Lack of work
Quit
Fired or Discharged
Labor Dispute
4b1. Name of company you separated from:
4b2. What was your last day of work?
5. Have you returned to full-time work which will not require you to file any further weekly claims at this time?
Yes
No
Failure to disclose that you have returned to work may result in prosecution and payment of restitution.
6. Do you choose to skip filing for the week because you did not meet the work search requirements in #2 above?
(DES temporarily suspended the “actively seeking work” requirement due to COVID-19. Your answer to question 6 will
not be used to determine your eligibility at this time.)
I am claiming benefits for the calendar week that ended on Saturday midnight, as shown above. I certify to the following:
I was registered for work and unemployed. The above statements are true and correct to the best of my knowledge.
I have reported all changes in writing. I understand that the law provides penalties for false statements made in
connection with this claim and if any issues arise from my answers above, the department will contact me.
Claimant’s Signature
Date
When completed, fax to:
You may also mail to: Arizona Department of Economic Security
602-364-1210 or 602-364-1211 (Phoenix)
Unemployment Insurance Benefits
520-770-3357 or 520-770-3358 (Tucson)
MD 5895
P.O. Box 29225
Phoenix AZ 85038-955
See page 2 (Instructions) for EOE/ADA disclosures.
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
UB-106-A -FF (4-20)
Page 2 of 2
Unemployment Insurance Program
Instructions for Completing Weekly Claim for UI Benefits
You must file a weekly claim each week. A determination will not be made until you file a weekly claim. All weekly claims are
for a calendar week which starts at 12:01 a.m. Sunday and ends at 12:00 midnight on the following Saturday. Weekly claims
cannot be filed until after the calendar week has ended.
Below is a brief explanation for each of the questions you will be required to answer each week.
1. Were you able to work and available for work each regular workday?
Able to work - You are able to work if you have no mental or physical condition that prevents you from working or
accepting work. For example, if your employer shuts down due to COVID-19 but you could accept other work, you are
able to work.
Available for work - You are available for work if you do not have any restrictions that would prevent you from looking for
or accepting full-time work when offered. For example, if your employer shuts down due to COVID-19 but you otherwise
could accept a job if offered (e.g. you have childcare, are not traveling out of town, etc.), then you are available for work.
2. Did you look for work?
DES temporarily suspended the “actively seeking work” requirement due to COVID-19. Your answer to question 2 will
not be used to determine your eligibility at this time.
3. Did you refuse any job offer or referral to work?
Refusing a job offer or referral to work – you turned down work that was offered to you or you did not report to an
employer that you were referred to from the Employment Service office. You are able to select “No” if you were made
a job offer that puts you at risk of exposure to COVID-19 or plan to return to your employer when operations resume.
4. Did you work or earn any money, including part-time work?
The department regularly matches hiring information with employer records. Failure to report earnings may
result in prosecution and payment of restitution. (If YES, you must answer 4a. and 4b.)
4a. What were your gross earnings before deductions?
If you performed any work or earned any money you must report it on your weekly claim. You must report the total
amount earned before deductions. Wages must be reported the week in which the work is performed even if you
have not been paid yet.
4b. Are you still working?
NO – Lack of work or a Reduction in force – laid off, no more work was available
Quit – Voluntarily left employment
Fired, discharged or Let go – Misconduct
Labor Dispute – A dispute or disagreement which results in a strike or lockout at the place of employment.
The department will confirm that a labor dispute exists.
5. Have you returned to full-time work which will not require you to file any further weekly claims at this time?
Failure to disclose that you have returned to work may result in prosecution and payment of restitution.
YES - that you are working and earning an income in excess of your weekly benefit amount and do not have to file a weekly
claim.
NO - you are still unemployed and wish to continue filing a weekly claim.
6. Do you choose to skip filing for the week because you did not meet the work search requirements in #2 above?
DES temporarily suspended the “actively seeking work” requirement due to COVID-19. Your answer to question 6 will
not be used to determine your eligibility at this time.
Equal Opportunity Employer / Program • Auxiliary aids and services are available upon request to individuals with disabilities
• To request this document in alternative format or for further information about this policy, contact your local office; TTY/TDD
Services: 7-1-1 • Disponible en español en línea o en la oficina local
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